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Definition

Stress incontinence is an involuntary loss of urine that occurs during physical activity, such as coughing, sneezing, laughing, or exercise.

Symptoms

The main symptom of stress incontinence is involuntary loss of urine. It may occur when:

* Coughing
* Sneezing
* Standing
* Exercising
* Engaging in other physical activity
* Engaging in sexual intercourse

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Definition

Primary infertility describes couples who have never been able to become pregnant after at least 1 year of unprotected sex (intercourse).

Secondary infertility describes couples who have been pregnant at least once, but have not been able to become pregnant again.

Symptoms

The physical symptom of infertility is the inability to become pregnant.

Experiencing infertility can bring on a range of painful emotions in one or both members of the couple. In general, having at least one child already tends to soften these painful emotions.

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Definition

Gynecologic cancers are malignant tumors within the female reproductive organs.

Description

Gynecologic cancers account for approximately 13% of all cancers that affect women. They are responsible for 10% of the cancer deaths among women.

The female reproductive tract is comprised of the ovaries, fallopian tubes, uterus, cervix, vagina, and vulva. Together, these organs allow a woman to become pregnant, protect and nourish an unborn baby, and to give birth. An understanding of each organ and its role in reproduction may help the patient to understand her particular gynecologic cancer. There are two ovaries, which are the internal organs dedicated to producing eggs. Released eggs are captured by the fallopian tubes, through which the egg (or fertilized egg) travels to the womb (uterus). The lining of the uterus (endometrium) responds to female hormones, such as estrogen, and becomes thickened to allow for implantation of a fertilized egg. The cervix is the opening of the uterus which opens (dilates) during labor to allow for passage of the baby. The vagina is a short tube that extends from the outer female genitalia (vulva) to the cervix.

Gynecologic cancers are defined not solely by the organ affected but also by the type of cancerous cells in the tumor. The type of cancer depends on the cell types that make up an organ. Adenocarcinomas are cancers that contain primarily cells originating from glands or ducts. Squamous cell carcinomas are tumors that arose from squamous cells, the main cell type found in skin. Sarcomas are cancers that originated from cells of basic connective tissue (mesenchymal cells). Sarcomas are comprised of cells that have become specialized (differentiated) and are named according to the predominant cell type. Endometroid tumors are those that originated from the endometrium. Clear-cell carcinoma is a rare gynecologic tumor that contains cells from the mullerian duct, which gives rise to the uterus, vagina, and fallopian tubes during development.

Because the reproductive organs are interconnected, spread of cancer from one organ to another (direct extension) is not uncommon. Gynecologic cancer carries the

Gynecologic cancers

Cancer type Occurs in Tumor types

Endometrial cancer Uterus Endometrioid tumors
Clear-cell carcinomas
Papillary serous
Sarcomas
Mixed tumors
Fallopian tube cancer Fallopian tubes, but frequently spreads Serous carcinomas
Mucinous tumors
Endometrioid tumors
Cervical cancer Cervix Squamous cell carcinomas
Adenocarcinomas
Clear-cell carcinoma
Serous carcinoma
Glassy-cell carcinoma
Ovarian cancer Ovaries Serous carcinomas
Mucinous tumors
Endometrioid tumors
Vaginal cancer Vagina Squamous cell carcinoma
Adenocarcinoma
Melanoma
Sarcoma
Vulvar cancer Vulva Squamous cell carcinomas
Melanoma
Basal cell carcinoma
Paget's disease
Adenocarcinomas

name of the organ where the cancer originated (primary cancer site). For example, a tumor restricted to the vagina would be "primary vaginal cancer, " whereas one that has extended from the cervix to the vagina would be "primary cervical cancer."

Types of cancers

Ovarian cancer is the second most common cancer of the female reproductive organs. It accounts for 30% of all gynecologic cancers and 53% of the deaths in this group. The high death rate associated with ovarian cancer is due to the fact that most women are not diagnosed until the cancer has progressed to an advanced stage. The average age at diagnosis is 63 years. Serous carcinomas are the most common type of ovarian cancer. Other common types of ovarian cancer include mucinous tumors and endometroid tumors.

Fallopian tube cancers, as primary cancers, are very rare. They frequently spread widely within the abdominal cavity. Although often diagnosed earlier than ovarian cancer, fallopian tube cancer produces similar symptoms and originates from similar cell types as ovarian cancer.

Uterine cancer, also called endometrial cancer, is the most common gynecologic cancer and accounts for 46% of the cases. Endometrial cancer primarily affects postmenopausal women, however, 25% of cases are in premenopausal women. There are two types of endometrial cancer: estrogen-dependent and non-estrogen-dependent. Estrogen-dependent cancers are usually comprised of well-differentiated cells and are associated with a good outcome and a long survival time. Nonestrogen-dependent cancers are usually made up of poorly-differentiated cells and are invasive and associated with a poor prognosis. Uterine tumors are most frequently endometroid tumors, usually adenocarcinomas. Clear-cell carcinomas, papillary serous, sarcomas, and mixed tumors also occur.

Cervical cancer is the third most common cancer of the female reproductive tract. It accounts for 17% of the gynecologic cancers. Although cervical cancer can affect any adult woman, there are peaks of occurrence around the ages of 37 years and 62 years. Between 60% and 80% of the cases of cervical cancer are squamous cell carcinomas with the remainder being adenocarcinomas. Clear-cell carcinoma, serous carcinoma, and glassy-cell carcinoma are less frequent cervical cancers. Cervical cancer is very strongly associated with human papilloma virus.

Vaginal cancer is rare and accounts for just 3% of the gynecologic cancers. It most often strikes women in their sixties. Greater than 90% of the vaginal cancers are squamous cell carcinomas. Adenocarcinoma, melanoma, and sarcoma account for the remaining cases. There is an association between vaginal cancer and human papilloma virus.

Vulvar cancer is rare and accounts for 4% of the gynecologic cancers. It most often strikes women in their sixties. Squamous cell carcinoma is the most common type and melanoma is the second most common type of vulvar cancer. Other types of vulvar cancer include basal cell carcinoma, Paget's disease, and adenocarcinomas (arising from the Bartholin's, Skene's, or sweat glands). There is an association between vulvar cancer and human papilloma virus.

Resources

BOOKS

Fields, A., J. Jones, G. Thomas, and C. Runowicz. "Gynecologic Cancer." In Clinical Oncology. Lenhard, Raymond, Robert Osteen, and Ted Gansler, eds. Atlanta: American Cancer Society, 2000.

PERIODICALS

Brown, Jean, and Anne Cloutier. "Gynecologic Cancers."American Journal of Nursing 100 (April 2000): 32-5.

Zanotti, Kristine, and Alexander Kennedy. "Screening for Gynecologic Cancer." Medical Clinics of North America 83, no. 6 (November 1999): 1467-87.

ORGANIZATIONS

American Cancer Society. 1599 Clifton Rd. NE, Atlanta, GA 30329. (800) ACS-2345. .

Cancer Research Institute, National Headquarters. 681 Fifth Ave., New York, NY 10022. (800) 992-2623. .

Gynecologic Cancer Foundation. 401 N. Michigan Ave., Chicago, IL 60611. (800) 444-4441 or (312) 644-6610. .

National Institutes of Health. National Cancer Institute. 9000Rockville Pike, Bethesda, MD 20982. (800) 4-CANCER. .

Belinda Rowland, Ph.D.

Differentiated

—A term describing cells that have become specialized and have matured normally, such as muscle cells.

Direct extension

—The spread of cancer directly from one organ to a neighboring organ, such as from the cervix to the vagina.

Glassy cell carcinoma

—Tumorous cells that have a glass-like appearance

Human papilloma virus (HPV)

—A sexually-transmitted virus that causes genital warts. It is associated with certain gynecologic cancers.

Mucinous tumors

—Adenocarcinomas that produce significant amounts of the complex sugar molecule known as mucin.

Papillary serous carcinoma

—A serous carcinoma with papillary (nipple-like) outgrowths.

Primary cancer (or tumor)

—The organ in which a cancerous tumor originated.

Serous carcinoma

—A carcinoma that produces or contains serum, the liquid portion of blood.

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Definition

Felty syndrome is a rare disorder that involves rheumatoid arthritis, a swollen spleen, decreased white blood cell count, and repeated infections.

Symptoms

* General feeling of discomfort (malaise)
* Fatigue
* Loss of appetite
* Unintentional weight loss
* Pale-looking skin
* Joint swelling, stiffness, pain, and deformity
* Recurrent infections
* Eye burning or discharge

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Definition

Bowel incontinence is the loss of bowel control, leading to an involuntary passage of stool. This can range from occasionally leaking a small amount of stool and passing gas, to completely losing control of bowel movements.

Urinary incontinence, a separate topic, is the inability to control the passage of urine.

Symptoms

Fecal incontinence can result from a wide variety of medical conditions, including childbirth-related anal injuries, other causes of damage to the anus or rectum, and nervous system problems.

Vaginal-delivery childbirth is a major cause of fecal incontinence. In many cases, childbirth results in damage to the anal sphincter, which is the ring of muscle that closes the anus and keeps stools within the rectum until a person can find an appropriate opportunity to defecate. Nerve injuries during childbirth may also be a factor in some cases. A study in 2000 by the Brigham and Women's Hospital in Boston, Massachusetts, found that women who had episiotomies were at higher risk for postpartum fecal incontinence. Childbirth-related incontinence is usually restricted to gas, but for some women it involves the passing of liquid or solid stools.

The removal of hemorrhoids by surgery or other techniques (hemorrhoidectomies) can also cause anal damage and fecal incontinence, as can more complex operations affecting the anus and surrounding areas. Anal and rectal infections, as well as Crohn's disease, can lead to incontinence by damaging the muscles that control defecation. New-onset fecal incontinence can also be a sign of colorectal cancer. For some people, incontinence becomes a problem when the anal muscles begin to weaken in midlife or old age.

Dementia, mental retardation, strokes, brain tumors, multiple sclerosis, and other conditions that affect the nervous system can cause fecal incontinence by interfering with muscle function or the normal rectal sensations that trigger sphincter contraction and are necessary for bowel control. One study of multiple sclerosis patients discovered that about half were incontinent. Nerve damage caused by long-lasting diabetes mellitus (diabetic neuropathy) is another condition that can give rise to incontinence.

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Definition

A fecal impaction is a large mass of dry, hard stool that can develop in the rectum due to chronic constipation. This mass may be so hard that it cannot come out of the body. Watery stool from higher in the bowel may move around the mass and leak out, causing soiling or diarrhea.

Symptoms

* Abdominal cramping
* Frequent straining with passage of liquid
* Rectal bleeding
* Small, semi-formed stools
* Sudden, watery diarrhea in someone who has chronic constipation

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Definition

Fanconi's anemia is disease passed down through families (inherited) that mainly affects the bone marrow. It results in decreased production of all types of blood cells.

Fanconi's anemia is different from Fanconi syndrome, a rare kidney disorder.

Symptoms

Person's with Fanconi's anemia have lower-than-normal numbers of white blood cells, red blood cells, and platelets (cells that help the blood clot).

Not enough white blood cells can lead to infections. A lack of red blood cells may result in fatigue (anemia).

A lower-than-normal amount of platelets may lead to excess bleeding.

Most people with Fanconi's anemia have these types of symptoms:

* Abnormal heart, lungs, and digestive tract
* Bone problems (especially the hips, spine or ribs, can causes a curved spine (scoliosis)
* Changes in the color of the skin, such as:
o Darkened areas of the skin
o Vitiligo
* Deafness due to abnormal ears
* Eye or eyelid problems
* Kidney(s) that did not form correctly
* Problems with the arms and hands, such as:
o Missing, extra or misshapen thumbs
o Problems of the hands and the bone in the lower arm
o Small or missing bone in the forearm
* Short height
* Small head
* Small testicles and genital changes

Other possible symptoms:

* Failure to thrive
* Learning disability
* Low birth weight
* Mental retardation

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Definition

Familial hypercholesterolemia is a condition passed down through families in which a person has high levels of "bad" cholesterol (low density lipoprotein, or LDL) beginning at birth. The condition can cause heart attacks at an early age.

See also:

* Familial combined hyperlipidemia
* Familial hypertriglyceridemia
* Familial dysbetalipoproteinemia

Symptoms

Symptoms that may occur include:

* Fatty, cholesterol-rich skin deposits (xanthomas)
* Cholesterol deposits in the eyelids (xanthelasmas)
* Chest pain (angina) associated with coronary artery disease
* Obesity

Persons with either one or two copies of the defective gene can develop fatty skin deposits over their elbows, knees, buttocks, tendons, and around the cornea of the eye.

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Definition

Fainting is a temporary loss of consciousness due to a drop in blood flow to the brain. The episode is brief (lasting less than a couple of minutes) and is followed by rapid and complete recovery. You may feel light-headed or dizzy before fainting.

A longer, deeper state of unconsciousness is often called a coma.

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Definition

Failure to thrive is a description applied to children whose current weight or rate of weight gain is significantly below that of other children of similar age and sex.

Symptoms

Infants or children who fail to thrive have a height, weight, and head circumference that do not match standard growth charts. The person's weight falls lower than 3rd percentile (as outlined in standard growth charts) or 20% below the ideal weight for their height. Growing may have slowed or stopped after a previously established growth curve.

The following are delayed or slow to develop:

* Physical skills such as rolling over, sitting, standing and walking
* Mental and social skills
* Secondary sexual characteristics (delayed in adolescents)

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Definition

Factor X deficiency is a disorder caused by too little of a protein called factor X in the blood. It leads to problems with blood clotting (coagulation).

Symptoms

* Nosebleeds (epitaxis)
* Bleeding into joints
* Muscle bleeding
* Mucous membrane bleeding

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Definition

Factor VII deficiency is an inherited disorder in which a lack (deficiency) of plasma protein factor VII leads to abnormal bleeding.

Symptoms

* Bleeding from mucus membranes
* Bleeding into joints
* Bleeding into muscles
* Excessive bruising
* Excessive menstrual bleeding
* Nosebleeds (epistaxis)

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Definition

Factor V deficiency is an inherited condition that affects the ability of the blood to clot.

Symptoms

* Bleeding into the skin
* Bleeding of the gums
* Excessive bruising
* Excessive menstrual bleeding
* Nosebleeds
* Prolonged or excessive loss of blood with surgery or trauma
* Umbilical stump bleeding

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Definition

Factor II deficiency is a blood clotting (coagulation) problem that occurs when there is a lack of a substance (prothrombin) that is needed for blood to clot.

Symptoms

* Abnormal bleeding after delivery
* Abnormal menstrual bleeding
* Bleeding after surgery
* Bleeding after trauma
* Bruising
* Nosebleeds (epistaxis)
* Umbilical cord bleeding at birth

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VISION DISORDERS

Human vision is dependent on the successful interaction of optical structures in the eye. When these structures malfunction, vision disorders occur. The key to treatment and resolution of these disorders is early detection through regular eye exams and prompt consultation with an ophthalmologist when problems occur.

The best way to describe how vision works is to use the analogy of a camera. The pupil manages the incoming light rays, opening and closing—like a camera shutter—according to the amount of light available. These light rays are progressively refracted and focused by three structures: the cornea, a transparent, convex cover over the iris and pupil in front of the eye; the lens, a spherical body behind the cornea, and the vitreous humor, a gelatinous substance that fills the back of the eyeball. It is important that the rays be in sharp focus when they reach the retina, a sensory membrane that lines the back of the eye and acts like film in a camera. The retina converts the light rays into electrical signals that are sent to the brain by way of the optic nerve. The brain then translates these electrical signals into what we know as sight.

Refractive Errors. The most common vision disorders are refractive errors—specifically nearsightedness, farsightedness, and astigmatism. In each case, the eye does not refract the incoming light properly, so the image is blurred. While they are not diseases, refractive errors affect every age range and comprise the largest treatment effort of ophthalmologists. Refractive errors can be successfully corrected with eyeglasses, contact lenses, and laser refractive surgery.

Cataract. A cataract results when the normally transparent lens of the eye clouds, blurring vision. Most cataracts are age-related, advancing slowly and progressively until functional blindness occurs. Cataract cannot be prevented or cured with medication or optical devices, but it can be successfully treated through a surgical procedure that removes the damaged, natural eye lens and replaces it with a permanent, intraocular lens implant. The procedure has over a 90 percent success rate. After refractive errors, cataract is the most common vision disorder.

Macular Degeneration. Located in the retina, the macula is responsible for central vision. When people have macular degeneration, they can no longer bring the center of the picture they see into focus. The most common type of the disease is agerelated, and there are two forms: "wet" and "dry." Whereas the wet form comprises only about 10 percent of cases, it causes the greatest vision loss, striking quickly and without warning as a result of erupting blood vessels. The dry form is characterized by a slow, progressive loss of vision from the thinning and tearing of the macula. Although both forms are being extensively researched, definitive causes and treatments have not yet been identified. Age-related macular degeneration is the leading cause of blindness in most developed countries.

Glaucoma. Glaucoma is a disease of the optic nerve. If the aqueous humor (the clear fluid that fills the front of the eye) does not drain properly, intraocular pressure builds, damaging the optic nerve and causing blind spots to develop. When the entire nerve is destroyed, blindness results. If glaucoma is detected and treated in the early stages, loss of vision can be averted. However, the disease is chronic and cannot be cured or reversed. Unfortunately, the early stages are symptomless. Once symptoms occur, usually manifested by loss of peripheral or side vision, irreversible vision loss has already taken place. Treatment consists of medication and/or surgery, depending on the type of glaucoma, the patient's medical history, and the stage of the disease. Glaucoma is the leading cause of blindness worldwide and the second-leading cause in developed countries.

Diabetic Retinopathy. Retinopathy is a side effect of diabetes and occurs as a result of fluctuations in the body's blood sugar, a daily problem for diabetics. When blood sugar fluctuates over time, it affects the blood vessels in various parts of the body, including the retina of the eye, where the blood vessels can break and bleed, causing blurred vision. The longer a person has diabetes, the higher the risk of retinopathy; good diabetic control can forestall the disease, however. Signs of retinopathy often occur before symptoms appear. Treatment includes the use of laser photocoagulation to seal leaking blood vessels. Often undetected and untreated, diabetic retinopathy is the leading cause of visual disability among working-age people.

Retinal Degenerations. Retinal degeneration is an umbrella term for a number of hereditary and degenerative disorders that range from mild to profound vision loss and blindness. Retinitis pigmentosa is the most common type of retinal degeneration, affecting one in three thousand people. Its many forms have widely varied symptoms, and onset and progress of the disease can be slow or rapid. In general, symptoms occur in childhood or young adulthood. Patients complain of night blindness followed by loss of visual field. There is no treatment, though researchers are hopeful that genetic therapies may be possible in the future.

Strabismus. Unlike most other vision disorders, strabismus is a physical defect. One or both of the eyes are misaligned and point in different directions. One eye may look ahead while the other eye points up, down, in, or out. Strabismus is more common in children than in adults. In adults it can be a side effect of head trauma or brain disorder. Treatment may involve eyeglasses, an eye patch (in some cases), or surgery on the eye muscles.

BARBARA L. PAWLEY

(SEE ALSO: Diabetes Mellitus)

BIBLIOGRAPHY

O'Toole, M. (1997). Miller-Keane Encyclopedia & Dictionary of Medicine, Nursing, & Allied Health, 6th edition. Philadelphia, PA: W.B. Saunders.

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Definition

A cancerous growth in any part of the eye.

Symptoms

Genetics is thought to play a role in eye cancer. In regards to retinoblastoma, it is believed that if a tumor develops only in one eye then it isn't hereditary. However, if a tumor occurs in both eyes then it is hereditary. Those who have hereditary retinoblastoma have a rare risk of developing a tumor in the brain and should be monitored on a regular basis.

The cause of intraocular melanoma is still vague. Genetics could play a role, but age is also a factor. Inter-estingly enough, this type of cancer is seen most often in white people from a northern European descent.

The symptoms of this type of cancer usually begin with blurred vision and tenderness of the eye. Advanced symptoms may include loss of vision. If these symptoms persist a person should make an appointment with their ophthalmologist.

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Definition

Hemorrhoids are painful, swollen veins in the lower portion of the rectum or anus.

Symptoms

Symptoms of hemorrhoids include:

* Anal itching
* Anal ache or pain, especially while sitting
* Bright red blood on toilet tissue, stool, or in the toilet bowl
* Pain during bowel movements
* One or more hard tender lumps near the anus

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Definition

Ewing's sarcoma is a malignant (cancerous) bone tumor that affects children.

Symptoms

* Fever (can occur)
* Pain at the site of the tumor
* Swelling at the site of the tumor (occasionally)

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Definition

Essential hypertension refers to high blood pressure with no identifiable cause.

Symptoms

Usually, high blood pressure has no symptoms at all. That is why it is often called the "silent killer." Millions of people have high blood pressure and many do not even know they have this serious condition.

Rarely, you may experience a mild headache when your blood pressure is elevated. If your headache is severe, or if you experience any of the symptoms below, you must be seen right away because these may be a sign of dangerously high blood pressure (called malignant hypertension) or a serious complication (like a heart attack).

* Fatigue
* Confusion
* Visual changes
* Nausea and vomiting
* Anxiety
* Perspiration
* Pale or red skin
* Angina-like pain, crushing chest pain

Note: There are usually no symptoms.

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Definition

Esophagitis is a general term for any inflammation, irritation, or swelling of the esophagus, the tube that leads from the back of the mouth to the stomach.

See also:

* Esophagitis Candida
* Esophagitis CMV
* Esophagitis herpes

Symptoms

The infection or irritation may cause the tissues to become inflamed and occasionally form ulcers. Symptoms may include:

* Difficulty swallowing
* Painful swallowing
* Heartburn (acid reflux)
* Oral lesions (herpes)

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Definition

Candida esophagitis is a yeast infection of the esophagus, the tube that carries food from the mouth to the stomach.

See also:

* Candida-associated diaper dermatitis
* Candidiasis - oral
* Vaginal candidiasis

Symptoms

Symptoms include:

* Difficulty swallowing
* Fever (only if the fungus spreads further)
* Oral thrush (Candida in the mouth)
* Painful swallowing

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Definition

Esophageal cancer is a cancerous (malignant) tumor of the esophagus, the muscular tube that moves food from the mouth to the stomach.

See also: Barrett's esophagus

Symptoms

* Backwards movement of food through the esophagus and possibly mouth (regurgitation)
* Chest pain unrelated to eating
* Difficulty swallowing solids or liquids
* Heartburn
* Vomiting blood
* Weight loss

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Definition

Erysipelas is a type of skin infection (cellulitis).

Symptoms

* Blisters
* Fever, shaking, and chills
* Painful, very red, swollen, and warm skin underneath the sore (lesion)
* Skin lesion with a raised border
* Sores (erysipelas lesions) on the cheeks and bridge of the nose

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Symptoms

The main symptom is the inability to attain or maintain adequate erection to complete sexual activity.

As a result of this symptom, affected men may also experience depression and distress, and this symptom can cause interpersonal (including marital) issues.

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Definition

Epilepsy is a brain disorder involving repeated, spontaneous seizures of any type. Seizures ("fits," convulsions) are episodes of disturbed brain function that cause changes in attention or behavior. They are caused by abnormally excited electrical signals in the brain.

See also: Seizures

Symptoms

The severity of symptoms can vary greatly, from simple staring spells to loss of consciousness and violent convulsions. For most people with epilepsy, each seizure is similar to previous ones. The type of seizure a person has depends on a variety of things, such as the part of the brain affected and the underlying cause of the seizure.

An aura consisting of a strange sensation (such as tingling, smelling an odor that isn't actually there, or emotional changes) occurs in some people prior to each seizure.

For a detailed description of the symptoms associated with a specific type of seizure, see:

* Absence (petit mal) seizure
* Generalized tonic-clonic (grand mal) seizure
* Partial (focal) seizure

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Definition

Epiglottitis is inflammation of the cartilage that covers the trachea (windpipe).

See also: Croup

Symptoms

Epiglottitis begins with a high fever and sore throat. Other symptoms may include:

* Abnormal breathing sounds (stridor)
* Chills, shaking
* Cyanosis (blue skin coloring)
* Drooling
* Difficulty breathing (patient may need to sit upright and lean slightly forward to breathe)
* Difficulty swallowing
* Voice changes (hoarseness)

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Definition

An epidural hematoma is a pocket of blood that forms immediately outside the dura mater. The dura mater is the fibrous outermost sheath or membrane that encloses the brain and spinal cord. Epidural means outside the dura, and hematoma means mass of blood.

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Definition

Epididymitis is swelling (inflammation) of the epididymis, the tube that connects the testicle with the vas deferens.

Symptoms

Epididymitis may begin with a low-grade fever, chills, and a heavy sensation in the testicle. The testicle becomes more and more sensitive to pressure.

Other symptoms include:

* Blood in the semen
* Discharge from the urethra (the opening at the end of the penis)
* Discomfort in the lower abdomen or pelvis
* Fever
* Groin pain
* Lump in the testicle
* Pain during ejaculation
* Pain or burning during urination
* Painful scrotal swelling (epididymis is enlarged)
* Tender, swollen groin area on affected side
* Testicle pain that gets worse during a bowel movement

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Definition

Entropion involves the turning in of the edges of the eyelid (usually the lower eyelid) so that the lashes rub against the eye surface.

Symptoms

* Decreased vision if the cornea is damaged
* Excessive tearing
* Eye discomfort or pain
* Eye irritation
* Redness

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Definition

Enteritis is inflammation of the small intestine.

Symptoms

The symptoms may begin hours to days after you become infected. Symptoms may include:

* Abdominal pain
* Diarrhea - acute and severe
* Loss of appetite
* Vomiting - rare

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Definition

Campylobacter enteritis is an infection of the small intestine with Campylobacter jejuni bacteria.

Symptoms

* Cramping abdominal pain
* Fever
* Watery diarrhea, sometimes bloody

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Definition

Enlarged adenoids refers to swollen lymphatic tissue in the back of the nose. The tissue is similar to the tonsils.

Symptoms

* Bad breath
* Cracked lips
* Dry mouth
* Frequent ear infections
* Intermittent sleep apnea
* Mouth breathing (mostly at night)
* Mouth open during day (more severe obstruction)
* Persistent runny nose or nasal congestion
* Restlessness while sleeping
* Snoring

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Definition

Endometriosis is a condition in which the tissue that behaves like the cells lining the uterus (endometrium) grows in other areas of the body, causing pain, irregular bleeding, and possible infertility.

The tissue growth (implant) typically occurs in the pelvic area, outside of the uterus, on the ovaries, bowel, rectum, bladder, and the delicate lining of the pelvis. However, the implants can occur in other areas of the body, too.

Symptoms

Pain is the main symptom for women with endometriosis. This can include:

* Painful periods
* Pain in the lower abdomen or pelvic cramps that can be felt for a week or two before menstruation
* Pain in the lower abdomen felt during menstruation (the pain and cramps may be steady and dull or severe)
* Pain during or following sexual intercourse
* Pain with bowel movements
* Pelvic or low back pain that may occur at any time during the menstrual cycle

Note: Often there are no symptoms. In fact, some women with severe cases of endometriosis have no pain at all, whereas some women with mild endometriosis have severe pain.

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Definition

Endometrial cancer is cancer that starts in the endometrium, the lining of the uterus (womb).

Symptoms

* Abnormal uterine bleeding, abnormal menstrual periods
o Bleeding between normal periods before menopause
o Vaginal bleeding or spotting after menopause
* Extremely long, heavy, or frequent episodes of vaginal bleeding after age 40
* Lower abdominal pain or pelvic cramping
* Thin white or clear vaginal discharge after menopause

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Definition

The endocrine system is a widespread group of glands and organs that acts as the body's control system for producing, storing, and secreting chemical substances called hormones.

Description

The primary glands that compose the endocrine system are the hypothalamus, pituitary, thyroid, parathyroid, adrenal, pineal, ovary, and testes. The pancreas, considered both an organ and a gland, is also part of the system. The thymus is sometimes considered an endocrine-system organ. Although not part of the endocrine system, other organs that secrete hormones are the heart, brain, lungs, kidneys, liver, skin, and placenta. The word "endocrine" means that in response to specific stimuli, the hormones produced by the glands are released into the bloodstream.

Function

Hormones are compounds produced by the endocrine glands. They generally control the growth, development, and metabolism of the body; the electrolyte composition of body fluids; and reproduction. The specific functions of the endocrine glands and pancreas are unique.

Pituitary gland

The pituitary is the master gland of the endocrine system. Located at the base of the brain, the gland, which is about the size of a marble, consists of two parts: anterior and posterior. The anterior pituitary produces hormones that either stimulate other glands (such as adrenal, testis, ovary, and thyroid) to produce target-gland hormones, or directly affect the target organs.

Three of these hormones—adrenocorticotropic hormone (ACTH), gonadotropins, and thyroid-stimulating hormone (TSH)—act on other glands. ACTH stimulates the adrenal cortex to produce corticosteroid hormones and small amounts of male and female sex hormones. Gonadotropins are two hormones that regulate the production of male and female sex hormones and the egg (ova) and sperm (spermatozoa) cells. TSH stimulates the thyroid gland to produce and release thyroid hormone.

Another pituitary hormone, growth hormone (GH), has a central role in controlling the growth and development of the body and its components, including organs, tissue, and muscle. It also affects the metabolism of carbohydrates, protein, and fat. For example, GH increases glucose levels in the blood by reducing the amount of glucose used by muscle cells and adipose tissue and by promoting glucose production from certain liver molecules. Other functions of GH include increasing the amount of amino acids that cells take from the blood and stimulating the breakdown of lipids (fats) in adipose tissue. The pituitary hormone prolactin acts with other hormones in female breast development and helps regulate breast-milk production (lactation).

Two hormones, vasopressin and oxytocin, are stored but not produced in the posterior pituitary. Vasopressin, also called arginine vasopressin (AVP), helps the body to conserve water by increasing reabsorption of water from the kidneys. Oxytocin stimulates contractions in the uterus during childbirth and activates milk injection caused by an infant sucking on the breast.

Adrenal glands

The adrenals are small glands on top of the kidneys. The adrenals have two parts: an outer layer called the cortex, and an inner layer called the medulla. The adrenal cortex produces a variety of hormones called corticosteroids, including hydrocortisone (cortisol), which helps increase blood glucose levels. It also reduces the amount of glucose absorbed by muscles and adipose tissue. Another function of cortisol is to protect the body from the adverse affects of stress, including emotional and physical trauma.

The adrenal medulla produces adrenaline and noradrenaline, substances that increase the heart rate and blood pressure during times of stress. Their action is referred to as the "fight-or-flight" response.

Thyroid gland

The thyroid gland is composed of two sections in front of the windpipe and below the voice box. It produces two hormones, thyroxine (T4) and tri-iodothyronine (T3), which together are called the thyroid hormones. They help regulate growth and development and help in childhood brain development. The thyroid also contains cells that produce the hormone calcitonin, which helps to maintain normal calcium levels in the blood.

Parathyroid glands

The parathyroid complex is composed of four small glands, each the size of a pea, and each located on the four corners of the thyroid gland. They secrete parathyroid hormone, which regulates calcium levels in the blood.

Pancreas

The pancreas is located in the upper abdomen, just behind and below the stomach. It has two functions: to produce various enzymes that aid in digestion; and to produce insulin and glucagon, hormones that are key to the body's management of glucose (sugar) in the blood.

The primary purpose of insulin is to lower blood-glucose levels in the body. It helps form glycogen, proteins, and lipids, which are stored in the body (usually in the liver, muscles, and adipose tissue) to be used for energy. Glucagon increases blood-glucose levels, an action opposite to that of insulin. A strict balance between the glucagon and insulin is required to maintain proper blood-sugar levels.

Hypothalamus

Located deep inside the brain, the hypothalamus maintains direct control of the pituitary gland. It acts as the central "control room" of the endocrine system, directing the activities of the other parts of the system. These activities include regulating eating and drinking, sexual behavior, blood pressure, heart rate, body temperature, emotions, and the sleeping/waking cycle. When the brain receives information indicating that hormonal changes are needed somewhere in the body, the hypothalamus secretes chemicals that stimulate or suppress hormone production in the pituitary gland.

Pineal and thymus

The pineal is located in the center of the brain. This gland secretes melatonin, a hormone that helps regulate the sleeping/waking cycle. Disturbances in the production of melatonin causes jet lag, experienced by many long-distance travelers. Melatonin also influences development of the male and female sex glands. The thymus processes lymphocytes in infants and is partly responsible for immune-system development.

Ovaries and testes

The ovaries and testes, also called the sex glands, produce cells and hormones essential to reproduction and development of the body, including male and female sex characteristics. The three types of sex hormones are estrogens, progestogens, and androgens (including testosterone).

The main role of estrogens is to coordinate development and function of the female genitalia and breasts. Estrogens are also associated with the start of the menstrual bleeding cycle. Estrogen production in the ovary ceases during menopause. Estrogen is also produced in men (by the testes), though at lower levels than occur in women.

Progestogens are produced in the ovaries during part of the menstrual cycle, and in the placenta during pregnancy. They cause changes in the lining of the uterus to prepare it for pregnancy, and they act with estrogens to stimulate mammary-gland development in the breasts to prepare for lactation. Progesterone is the main progestogen hormone.

The primary androgen produced in the testes is the steroid testosterone. While mainly associated with male development, testosterone is produced in small amounts in women by the ovaries. During pregnancy, testosterone helps to develop the internal and external male sex organs. In males, testosterone promotes the growth of the sex organs and develops or stimulates male characteristics, such as deepening voice; growth of facial, pubic, and other body hair; and muscle growth and strength. In adult males, testosterone maintains the masculine characteristics and sexual potency and regulates sperm production.

Role in human health

A wide variety and dozens of symptoms can indicate a hormonal imbalance in the body. However, a specific group of symptoms give an initial indication of a problem in the endocrine system. For example, excessive thirst, frequent urination, and unexplained weight loss are classic signs of diabetes mellitus, the most common endocrine disorder. Many primary-care physicians still treat endocrine problems, especially diabetes, themselves. However, the primary care doctor often makes a preliminary diagnosis and then refers the patient to an endocrine-system specialist, called an endocrinologist.

Disorders of the endocrine system often, but not always, result from an over-or underproduction of a particular hormone. Too much or too little of a hormone can be harmful. The endocrine organs use a feedback mechanism to regulate hormone levels. It acts much like a household thermostat, increasing production of a specific hormone when it detects too little in the blood, or decreasing production when it detects too much or the right amount. Tight control of hormone levels is needed for the body to function properly. The endocrine organs secrete hormones directly into the bloodstream, where special proteins usually bind to them, helping to maintain them as they travel through the body.

Common diseases and disorders

There are two basic classes of endocrine disorders: problems associated with hormone-production levels, and problems caused by tissues that are unable to respond to hormones. Hormone-production disorders are broken into two groups: insufficient hormone production, called hypofunction; and too much hormone production, called hyperproduction. Endocrine-system disorders include the following:

* Diabetes mellitus is a disease that includes type 1 and type 2 diabetes. Type 1 is an autoimmune disease caused when the immune system destroys certain insulin-producing cells in the pancreas. This causes the pancreas to produce little or no insulin. Type 1 diabetes usually develops in children and young adults, but it can appear at any age. Symptoms include increased thirst and urination, unexplained weight loss, blurred vision, and extreme fatigue. There is no cure; insulin, first used in 1921, remains the only treatment. Type 2 diabetes accounts for 90% to 95% of diabetes cases. It usually develops in adults over age 40 and is usually associated with obesity. In type 2, the pancreas produces insulin, but the hormone is not used effectively by the body, a condition called insulin resistance. Several years after onset, insulin production decreases below the level needed to maintain glucose homeostasis. The result is the same as for type 1 diabetes: glucose builds up in the blood because the body cannot use it efficiently. Symptoms develop gradually and include increased thirst and urination, weight loss, fatigue, nausea, blurred vision, frequent infections, and wounds or sores that heal slowly. Insulin resistance is treated with drugs such as thiazolidinedions (rosiglitazone and pioglitazone) and biguanides (metformen). When insufficient insulin is produced, type 2 diabetes appears. However, research indicates progression of insulin resistance to type 2 diabetes can usually be halted or slowed with the insulin-resistance medications, or by lifestyle changes that result in weight loss.
* Hypothyroidism is caused by the thyroid gland producing too little thyroid hormone. It can lead to severe hypothyroidism, a disorder that usually develops after age 40. Symptoms include intolerance to cold, lethargy, fatigue, weight gain, and mental sluggishness. Congenital hypothyroidism is present at birth and has the same symptoms. If left untreated, it can lead to mental retardation. The standard treatment for both hypothyroid disorders is thyroid hormone-replacement medications such as levothyroxine (Synthroid, Unithroid, Levoxyl, and Levothroid) and triiodothyrine.
* Hyperthyroidism is due to an excess of thyroid hormones and affects women more frequently than men. Symptoms include nervousness, weight loss, intolerance to heat, diarrhea, heart palpitations, and insomnia. Some patients experience protruding eyes and trembling. Treatments include medications to inhibit thyroid-hormone production, and removal or destruction of the thyroid gland with radioactive iodine. The most common cause of the excessive thyroid production is Graves' disease, an autoimmune disorder of the thyroid gland.
* Addison's disease is caused by underactivity or immune-system destruction of the adrenal gland. It can be life-threatening if left untreated. Symptoms include weakness, fatigue, nausea, dehydration, fever, and hyperpigmentation (darkening of the skin without sun exposure.) The standard treatment is with corticosteroid hormones and adequate dietary salt.
* Cushing's syndrome and Cushing's disease are different disorders with similar symptoms: obesity, weakness, easily bruised skin, acne, and hypertension (high blood pressure.) Cushing's syndrome is usually caused by excessive production of glucocorticoid hormones in the adrenal gland. However, it can sometimes be caused by benign or cancerous tumors of the adrenal gland. Cushing's disease usually results from the overproduction of the adrenocoticotropic hormone in the pituitary gland, due to a benign tumor. Treatment for both disorders can include surgery, radiation therapy, chemotherapy, and blocking production of the glucorticoid hormones with drugs.
* Less common endocrine disorders include acromegaly, gigantism, and hypogonadism. Acromegaly occurs in adults and gigantism in children. Both are caused by a pituitary tumor that spurs overproduction of growth hormone. Hypogonadism causes delayed sexual maturity in children and infertility in adults. It is caused by underproduction of follicle-stimulating hormone (FSH) in the pituitary gland.

KEY TERMS

Adipose tissue—Connective tissue in which fat is stored and that has the cells distended by droplets of fat.

Autoimmune—A term that refers to a condition in which antibodies or T cells attack the molecules, cells, or tissue of the body organ or system producing them.

Electrolyte—A nonmetallic electric conductor in which current is carried by ion movement.

Lactation—The secretion of milk by the mammary gland in the breasts.

Lymphocytes—Weak cells produced in the lymphoid tissue.

Menopause—The period when natural menstruation stops, usually between ages of 45 and 50.

Menstruation—The discharge of blood from the uterus that occurs in approximately monthly intervals in females, starting at puberty.

BOOKS

Constanti, A., et al. Basic Endocrinology for Students of Pharmacy and Allied Health Sciences. Newark, NJ: Harwood Academic, 1998.

Hall, J. E., and L. Nieman, editors. Handbook of Diagnostic Endocrinology. Totowa, NJ: Humana Press, 2001.

Krentz, A. Churchill's Pocket Book of Diabetes. New York: Churchill Livingston, 2001.

Matthew, N. J. How the Endocrine System Works. Malden, MA: Blackwell Science, 2001.

Wilson, J. D., et al. Williams Textbook of Endocrinology. St. Louis, MO: W. B. Saunders, 1998.

PERIODICALS

American Diabetes Association. "Implications of the Diabetes Control and Complications Study." Diabetes Care (January 2001): 825.

Elliott, B. "Diagnosing and Treating Hypothyroidism." The Nurse Practitioner (March 2000): 92+.

Emanuele, N. and M. A. "The Endocrine System: Alcohol Alters Critical Hormonal Balance." Alcohol Health and Research World (Winter 1997): 53-64.

Hiller-Sturmhofel, S., and A. Bartke. "The Endocrine System: An Overview." Alcohol Health and Research World (Summer 1998): 153-154.

Lamberts, S. W. J., et al. "The Endocrinology of Aging." Science (October 17, 1997): 419-424.

Wilson, J. D. "Prospects for Research for Disorders of the Endocrine System." Journal of the American Medical Association (February 7, 2001): 624.

ORGANIZATIONS

American Association of Clinical Endocrinologists. 1000 Riverside Avenue, Suite 205, Jacksonville, FL 32204.(904) 353-7878. .

American Diabetes Association. 1701 North Beauregard Street, Alexandria, VA 22311. (800) 342-2383. .

American Thyroid Association. Montefiore Medical Center, 111 East 210th Street, Room 311, Bronx, NY 10467.(718) 882-6085. .

Endocrine Society. 4350 East West Highway, Suite 500, Bethesda, MD 20814. (301) 941-0200. .

Ken R. Wells

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Definition

The group of tumors that are associated with the hormone-secreting (endocrine) glands of the body.

Description

The glands in the body that make and secrete hormones comprise the endocrine system. All endocrine glands secrete hormones directly into the bloodstream, where they travel to a target organ or cell to trigger a specific reaction. These glands are primarily involved in controlling many of the slow and long-term activities in the body, such as growth, sexual development, and regulation of blood levels for many important proteins and essential chemical elements.

Endocrine glands are found in the head and neck region, the abdominal region, and the pelvic area (the region where the reproductive organs are located). The following are the main endocrine glands of the body:

* Pituitary gland. Found at the base of the brain, this small gland is important because it secretes several hormones that control the activity of other endocrine glands.
* Thyroid gland. Situated in the front of the neck, in the region of the Adam's apple, this gland secretes hormones that regulate body temperature, heart rate, and metabolism.
* Parathyroid glands. These four glands, with a pair on either side of the thyroid gland in the neck region, produce parathyroid hormone, which helps control the level of calcium in the blood.
* Pancreas. Found close to the stomach in the abdominal region, the pancreas contains two groups of cells. One group functions as an exocrine gland, secreting digestive enzymes into the intestines through a duct. The other, known as islets of Langerhans (or islet cells), functions as an endocrine gland and secretes hormones that control blood sugar levels and aid digestion.
* Adrenal glands. These two glands, one located above each kidney, secrete hormones that prevent inflammation and help regulate blood pressure, blood sugar levels, and metabolism.
* Ovary. A woman has two small ovaries in the pelvic area. They contain the egg cells and secrete the hormones progesterone and estrogen. These hormones have many functions, including controlling the onset of puberty, the timing of menstruation, and the changes associated with pregnancy.
* Testis (also called testicle). Men typically have two testes located outside the body in the lower pelvic area. They produce sperm and the hormone testosterone, which signals the onset of puberty, maintains the expression of male characteristics, such as facial hair, and stimulates sperm production.

Endocrine system tumors are rare. Although certain types are likely to be diagnosed as malignant (cancerous), endocrine tumors are often noncancerous (benign). Each year endocrine system cancers account for only around 4% of all new cancer cases in the United States. In 2001, it is expected that 53, 460 Americans will develop an endocrine system cancer, resulting in an estimated 16, 600 deaths.

The most common cancers of the endocrine system are ovarian cancer and thyroid cancer. Ovarian cancer represents about 44% of all endocrine system cancers and affects eight out of every 100, 000 American women. New cases of ovarian cancer in 2001 will likely reach over 23, 000, and nearly 13, 000 will die from the disease. Roughly six out of every 100, 000 Americans develop thyroid cancer, which accounts for 36% of all endocrine system cancers. It is estimated that 19, 000 new cases will be diagnosed in 2001 and result in 1, 300 deaths. Other malignant endocrine tumors are much rarer. Testicular cancer affects about two out of every 100, 000 American men, while the remaining cancer types combined affect roughly one out of every 100, 000 Americans.

Endocrine system tumors

Pituitary tumors

Thyroid tumors

Parathyroid tumors

Endocrine pancreatic tumors, including gastrinoma, insulinoma, and glucagonoma

Adrenal tumors, including pheochromocytoma and adrenocortical carcinoma

Ovarian tumors

Testicular tumors

Multiple endocrine gland tumors (tumors on several endocrine glands at once)

Many benign and malignant endocrine tumors are treatable with a combination of surgery and medication, and the survival rates for many endocrine cancers is good. Two exceptions are ovarian cancer and adrenocortical carcinoma, a tumor of the adrenal gland. About 50% of ovarian cancer patients and 40% of those diagnosed with an adrenocortical carcinoma will survive five years or more after the initial diagnosis. These cancers have poor survival rates because they are usually first diagnosed after they have spread or reached an advanced stage. Among the different cancers, thyroid cancer and testicular cancer have some of the better 5-year survival rates; both approach 95%.

Symptoms of many endocrine tumors are associated with the excessive secretion of hormones. Hormone-producing tumors are called functional tumors, while those that do not secrete hormones are called nonfunctional tumors. Both types are potentially malignant.

Types of cancers

Proceeding from the head region to the pelvic area, endocrine system tumors include:

* Pituitary tumors. These tumors are classified by the type of hormone they secrete. They are rarely malignant but can cause heath problems, including visual complications. One type of tumor results in Cushing's syndrome.
* Thyroid tumors. Only 5% of the tumors found on the thyroid are malignant. A malignant tumor can indicate one of the four types of thyroid cancer.
* Parathyroid tumors. Around 5% are malignant and result in a diagnosis of parathyroid cancer. Overproduction of parathyroid hormone, a condition known as hyperparathyroidism, is a common condition associated with both benign and malignant tumors. Untreated, hyperparathyroidism can result in osteoporosis (bones become brittle and fracture easily), kidney stones, peptic ulcers, and nervous system problems.
* Endocrine pancreatic tumors. Benign and malignant tumors are often treatable with surgery. Malignant tumors are rare. The most common types of tumors are a gastrinoma, which is associated with Zollinger-Ellison syndrome, insulinoma, and glucagonoma.
* Adrenal tumors. One type of tumor, a pheochromocytoma, is found on the inner part of the adrenal gland (the adrenal medulla). About 10% are malignant. An adrenocortical carcinoma is a malignant tumor on the outer part of the gland (adrenal cortex), and a common symptom is the occurrence of Cushing's syndrome. Both tumors are very rare.
* Ovarian tumors. Tumors can develop in the egg cells inside the ovary (germ cell tumors), but most occur in the cells lining the outside of the ovary, and most of these tumors are benign.
* Testicular tumors. Tumors can occur in one or both of the testes. Over 90% develop in the germ cells and only 4% involve the endocrine cells of the testes.
* Multiple endocrine gland tumors. Some disorders result in the simultaneous occurrence of tumors on several endocrine glands. Many of these are inherited disorders, including multiple endocrine neoplasia syndromes, Von Hippel-Lindau syndrome, and Von Recklinghausen's neurofibromatosis.

See Also Adenoma; Craniopharyngioma; >Neuroendocrine carcinomas; Pancreatic cancer, exocrine

Resources

BOOKS

Greenspan, Francis S., and Gordon J. Strewler. Basic and Clinical Endocrinology. Stamford, Conn: Appleton & Lange, 1997.

Wilson, Jean D., Charles Cameron, Daniel W. Foster, Donald W. Seldin, Henry M. Kronenberg, and P. Reed Larsen. Williams Textbook of Endocrinology. Philadelphia: W. B. Saunders, 1998.

PERIODICALS

Monson, J. C."The Epidemiology of Endocrine Tumours." Endocrine-Related Cancer 7 (2000): 29-36.

ORGANIZATIONS

American Association of Clinical Endocrinologists. 1000 Riverside Ave., Suite 205, Jacksonville, FL 32204. (904) 353-7878. .

OTHER

EndocrineWeb.com 3 July 2001 .

Monica McGee, M.S.

Endocrine gland

—Any gland that makes hormones and secretes them directly into the bloodstream.

Exocrine gland

—Any gland that secretes substances outward through a duct into a body cavity or onto a body surface (e.g., sweat glands and salivary glands).

Germ cell

—Any cell in the body that eventually produces either a mature egg cell (female) or a mature sperm cell (male).

Inherited disorder

—A disease that has a tendency to occur within a family. A disorder may be acquired due to a gene or genes that are passed from parent to child.

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Definition

Endocarditis is inflammation of the inside lining of the heart chambers and heart valves (endocardium).

See also:

* Culture-negative endocarditis
* Infective endocarditis

Symptoms

* Abnormal urine color
* Chills (common)
* Excessive sweating (common)
* Fatigue
* Fever (common)
* Joint pain
* Muscle aches and pains
* Night sweats
* Nail abnormalities (splinter hemorrhages under the nails)
* Paleness
* Red, painless skin spots on the palms and soles (Janeway lesions)
* Red, painful nodes in the pads of the fingers and toes (Osler's nodes)
* Shortness of breath with activity
* Swelling of feet, legs, abdomen
* Weakness
* Weight loss

Note: Endocarditis symptoms can develop slowly (subacute) or suddenly (acute).

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Definition

End-stage kidney disease is the complete, or almost complete failure of the kidneys to function. The kidneys can no longer remove wastes, concentrate urine, and regulate many other important body functions.

Symptoms

Symptoms may include:

* General ill feeling and fatigue
* Generalized itching (pruritus) and dry skin
* Headaches
* Weight loss without trying
* Loss of appetite
* Nausea

Other symptoms may develop, including:

* Abnormally dark or light skin and changes in nails
* Bone pain
* Brain and nervous system symptoms
o Drowsiness and confusion
o Problems concentrating or thinking
o Numbness in the hands, feet, or other areas
o Muscle twitching or cramps
* Breath odor
* Easy bruising, nosebleeds, or blood in the stool
* Excessive thirst
* Frequent hiccups
* Low level of sexual interest and impotence
* Menstrual periods stop (amenorrhea)
* Sleep problems, such as insomnia, restless leg syndrome, or obstructive sleep apnea
* Swelling of the feet and hands (edema)
* Vomiting, especially in the morning

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Definition

Encopresis is the voluntary or involuntary passage of stools in a child who has been toilet trained (typically over age 4), which causes the soiling of clothes.

See also: Bowel incontinence

Symptoms

* Inability to retain feces (bowel incontinence)
* Passing stool in inappropriate places (generally in the child's clothes)
* Secretive behavior associated with bowel movements
* Constipation and hard stools
* Occasional passage of very large stool that almost blocks up the toilet

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Definition

Hepatic encephalopathy is a worsening of brain function that occurs when the liver is no longer able to remove toxic substances in the blood.

Symptoms

Symptoms many begin slowly and gradually worsen, or they may begin suddenly and be severe from the start.

Symptoms may be mild at first. Family members or caregivers may notice that the patient has:

* Breath with a musty or sweet odor
* Change in sleep patterns
* Changes in thinking
* Confusion that is mild,
* Forgetfulness
* Mental fogginess
* Personality or mood changes
* Poor concentration
* Poor judgment
* Worsening of handwriting or loss of other small hand movements

More severe symptoms may include:

* Abnormal movements or shaking of hands or arms
* Agitation, excitement, or seizures (occur rarely)
* Disorientation
* Drowsiness or confusion
* Inappropriate behavior or severe personality changes
* Slurred speech
* Slowed or sluggish movement

Patients with hepatic encephalopathy can become unconscious, unresponsive, and possibly enter a coma.

Patients with hepatic encephalopathy are often not able to care for themselves because of these symptoms.

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Definition

Encephalitis is irritation and swelling (inflammation) of the brain, usually due to infections.

See also: Meningitis

Symptoms

When the virus enters the bloodstream, it may cause inflammation of brain tissue and surrounding membranes. White blood cells invade the brain tissue as they try to fight off the infection. The brain tissue swells (cerebral edema), which may destroy nerve cells, cause bleeding in the brain (intracerebral hemorrhage), and brain damage.

Symptoms include:

* Clumsiness, unsteady gait
* Confusion, disorientation
* Drowsiness
* Fever
* Headache
* Irritability or poor temper control
* Light-sensitivity
* Stiff neck and back (occasionally)
* Vomiting

Emergency symptoms:

* Loss of consciousness, poor responsiveness, stupor, coma
* Muscle weakness or paralysis
* Seizures
* Sudden change in mental functions:
o Diminished interest in daily activities
o "Flat" mood, lack of mood, or mood inappropriate for the situation
o Impaired judgment
o Inflexibility, extreme self-centeredness, indecisiveness, or withdrawal from social interaction
o Memory loss (amnesia), impaired short-term or long-term memory

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Definition

Empyema is a collection of pus in the space between the lung and the inside of the chest wall (pleural space).

Symptoms

* Chest pain, which worsens when you breathe in deeply (inspiration)
* Dry cough
* Excessive sweating, especially night sweats
* Fever and chills
* General discomfort, uneasiness, or ill feeling (malaise)
* Shortness of breath
* Unintentional weight loss

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Definition

Emphysema is a chronic respiratory disease where there is over-inflation of the air sacs (alveoli) in the lungs, causing a decrease in lung function, and often, breathlessness.

Symptoms

Heavy cigarette smoking causes about 80–90% of all emphysema cases. However a few cases are the result of an inherited deficiency of a substance called alpha-1-antitrypsin (AAT). The number of Americans with this deficiency is relatively small, probably no greater than 70, 000. Pipe, cigar, and marijuana smoking can also damage the lungs. While a person may be less likely to inhale cigar and pipe smoke, these types of smoke can also impair lung function. Marijuana smoke may be even more damaging because it is inhaled deeply and held in by the smoker.

The symptoms of emphysema develop gradually over many years. It is a common occurrence for many emphysema patients to have lost over half of their functioning lung tissue before they become aware that something is wrong. Shortness of breath, a chronic mild cough (which may be productive of large amounts of dark, thick sputum, and often dismissed as "smoker's cough"), and sometimes weight loss are associated with emphysema. Initially, a patient may only notice shortness of breath when he or she is exercising. However, as the disease progresses, it will occur with less exertion or no exertion at all. Emphysema patients may also develop an enlarged, or "barrel, " chest. Other symptoms may be skipped breaths, difficulty sleeping, morning headaches, increased difficulty breathing while lying down, chronic fatigue, and swelling of the feet, ankles, or legs. Those with emphysema are at risk for a variety of other complications resulting from weakened lung function, including pneumonia.

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Definition

This article describes aching or other discomfort in the elbow that is not related to direct injury.

Alternative Names

Pain - elbow

Common Causes

Elbow pain can be caused by a variety of problems. A common cause in adults is tendinitis, an inflammation and injury to the tendons -- soft tissues that attach muscle to bone.

People who play racquet sports are most likely to injure the tendons on the outside of the elbow. This condition is commonly called tennis elbow. Golfers are more likely to injure the tendons on the inside of the elbow.

Other common causes of elbow tendinitis are gardening, playing baseball, using a screwdriver, or overusing your wrist.

Young children commonly develop "nursemaid's elbow," usually when someone is pulling on their straightened arm. The bones are stretched apart momentarily and a ligament slips in between, where it becomes trapped when the bones try to snap back into place. Children will usually quietly refuse to use the arm, but often cry out with any attempt to bend or straighten the elbow. This condition is also called an elbow subluxation (a partial dislocation).

Other common causes of elbow pain are:

* Bursitis -- inflammation of a fluid-filled cushion beneath the skin
* Arthritis -- narrowing of the joint space and loss of cartilage in the elbow
* Elbow strains
* Infection of the elbow

Home Care

In adults, the following steps can help treat many cases of elbow pain:

* When you first notice the pain, apply ice up to 15 minutes every hour for the first day. Continue to apply ice every 3 to 4 hours for up to 3 days. Wrap the ice in a cloth -- do not apply ice directly to the skin.
* Wrap the elbow with a bandage, such as an ACE bandage. You may need an air splint to keep the elbow immobilized.
* Keep the elbow elevated above your heart, if possible.
* Give the elbow joint complete rest for at least 2 days. DO NOT return to the activity that caused the problem for at least 3 weeks. Then, gradually strengthen the muscles around your elbow. A physical therapist can teach you how to do this.
* While you are resting the joint, take pain relievers such as acetaminophen or ibuprofen.
* After the initial rest period, you should begin to gradually strengthen the muscles around the elbow through gentle flexibility exercises.

Nursemaid's elbow can be treated in a doctor's office or emergency room.

Call your health care provider if

Contact your doctor if:

* You have a prolonged case of tendinitis that doesn't improve with home care.
* The pain is due to a direct elbow injury.
* There is obvious deformity.
* You are unable to use the elbow.
* You have fever or swelling and redness of your elbow.
* A child has elbow pain.

What to expect at your health care provider's office

Your doctor will perform a physical examination, including a thorough examination of the elbow, and ask questions such as:

* Are both elbows affected?
* Does the pain shift from the elbow to other joints?
* Is the pain over the outside bony prominence of the elbow?
* Did the pain begin suddenly and severely?
* Did the pain begin slowly and mildly and then get worse?
* Is the pain resolving spontaneously?
* Did the pain begin following an injury?

For chronic tennis elbow, your doctor may prescribe a pain reliever and a corticosteroid injection into the painful area. Usually no more than three such injections are performed. Surgery is a last resort.

For arthritis, physical therapy and analgesics may help. For infections, your doctor may prescribe antibiotics.

For bursitis, your doctor may need to drain fluid.

Prevention

* Reduce how much time you spend doing the activity that causes the pain.
* Warm up slowly. Stretch the forearm before, during, and after exercise.
* Use an "elbow sleeve" to help keep your elbow warm while playing.
* Use ice or ibuprofen after the activity to prevent swelling and pain, if you have had an elbow injury in the past.
* Prevent tennis elbow by using the correct grip size, a two-handed backhand, and racquet strings that are not too tight.
* Wear an "elbow band" over an injured or rehabilitated area to prevent further injury and reduce pain.
* Perform regular stretching and strengthening exercises (given to you by your physical therapist or doctor).
* To prevent nursemaid's elbow in children, do not pull on a straightened arm. Avoid lifting or holding the child up by the hands or forearm. Children who get nursemaid's elbow once can easily get it again. Usually this is outgrown by age 4.

References

Sellards R, Kuebrich C. The elbow: diagnosis and treatment of common injuries. Prim Care. 2005; 32(1): 1-16.

American College of Radiology (ACR) Expert Panel on Musculoskeletal Imaging. Chronic elbow pain. Reston, VA: American College of Radiology; 2001.

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Definition

Ehlers-Danlos syndrome is a group of inherited disorders marked by extremely loose joints, hyperelastic skin that bruises easily, and easily damaged blood vessels.

Symptoms

Symptoms of EDS include:

* Double-jointedness
* Easily damaged, bruised, and stretchy skin
* Easy scarring and poor wound healing
* Flat feet
* Increased joint mobility, joints popping, early arthritis
* Joint dislocation
* Joint pain
* Premature rupture of membranes during pregnancy
* Very soft and velvety skin
* Vision problems

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Definition

Eczema is a chronic skin disorder that involves scaly and itchy rashes.

Symptoms

* Blisters with oozing and crusting
* Dry, leathery skin areas
* Ear discharge or bleeding
* Intense itching
* Rash
o In children younger than age 2, skin lesions begin on the cheeks, elbows, or knees
o In adults, the rash is more commonly seen on the inside of the knees and elbows
* Raw areas of the skin from scratching
* Skin coloring changes -- more or less coloring than the normal skin tone (See: Skin abnormally dark or light)
* Skin redness or inflammation around the blisters

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Definition

An ectopic pregnancy is an abnormal pregnancy that occurs outside the womb (uterus). The baby cannot survive.

Symptoms

* Abnormal vaginal bleeding
* Amenorrhea
* Breast tenderness
* Low back pain
* Mild cramping on one side of the pelvis
* Nausea
* Pain in the lower abdomen or pelvic area

If the area of the abnormal pregnancy ruptures and bleeds, symptoms may get worse. They may include:

* Feeling faint or actually fainting
* Pain that is felt in the shoulder area
* Severe, sharp, and sudden pain in the lower abdomen

Internal bleeding due to a rupture may lead to shock. Shock is the first symptom of almost 20% of ectopic pregnancies.

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Definition

Eclampsia is seizures (convulsions) in a pregnant woman that are not related to brain conditions.

See also: Preeclampsia

Symptoms

* Muscle aches and pains
* Seizures
* Severe agitation
* Unconsciousness

Symptoms of preeclampsia include:

* Gaining more than 2 pounds per week
* Headach
* Stomach pain
* Swelling of the hands and face
* Vision problems

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Definition

Ebola hemorrhagic fever is a severe and often deadly illness that can occur in humans and in primates (monkeys, gorillas).

Ebola hemorrhagic fever has made worldwide news because of its destructive potential.

Symptoms

During the incubation period, which can last about 1 week, symptoms include:

* Arthritis
* Backache (low-back pain)
* Chills
* Diarrhea
* Fatigue
* Fever
* Headache
* Malaise
* Nausea
* Sore throat
* Vomiting

Late symptoms include:

* Bleeding from eyes, ears, and nose
* Bleeding from the mouth and rectum (gastrointestinal bleeding)
* Depression
* Eye inflammation (conjunctivitis)
* Genital swelling (labia and scrotum)
* Increased feeling of pain in skin
* Rash over the entire body that often contains blood (hemorrhagic)
* Roof of mouth looks red
* Seizures, coma, delirium

As many as 90% of patients die from the disease. Patients usually die from shock rather than from blood loss.

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EATING DISORDERS

The term "eating disorders" encompasses a group of problems that fall into two broad categories—overeating (binging), and undereating (anorexia)—sometimes referred to as "starving or stuffing." Eating disorders are most commonly found in young females during early adolescence. However, eating disorders affect both males and females at many stages in the life cycle. Although the conditions create physical problems, the causes are usually psychological.

Eating disorders have been recognized by health experts for many years. Bulimia symptoms were described by the Egyptians, Hebrews, and Greeks; and anorexia nervosa was first described in the 1600s. However, it was not until 1980 that these conditions were categorized as psychiatric disturbances.

Eating disorders are marked by extreme dissatisfaction and preoccupation with body size and shape. People with these disorders may see themselves as overweight when their weight is actually lower than normal, or they may measure their self-worth by their weight. Emotional disturbance accompanies disordered eating, including self-loathing over amounts eaten or panic about possible weight gain. In addition to overeating or undereating, individuals with eating disorders engage in "compensatory behaviors," such as purging (self-induced vomiting or inappropriate use of laxatives, enemas, or diuretics), fasting, excessive exercise, and restricting (overly strict limiting of calories or food types).

Eating disorders can be distinguished from dieting by the psychological distress that accompanies the concern about weight; by the interference with everyday responsibilities and pleasures; and by the danger of causing medical problems, possibly even death.

Shame and secrecy often accompany eating disorders, and the problem may go undetected for years. Recognition of these disorders is necessary to begin the long process of treatment. Unlike other addictive or habit problems, food cannot be avoided, and recovery requires developing a healthier relationship to food and to one's own body, as well as improved coping skills.

TYPES OF EATING DISORDERS

Mental health professionals recognize three main types of eating disorders, anorexia nervosa, bulimia nervosa, and binge eating.

Anorexia. Although the word "anorexia" literally means "without appetite," the condition is better described as "restricted eating" or "self-starvation." The person with anorexia has an appetite, and food tastes good; however, food is seen as "the enemy." One authority terms anorexia "food phobia." The disorder is characterized by a refusal to maintain a minimal normal body weight, an intense fear of gaining weight, a disturbance in the self-perception of body size and shape, and (in women) an absence of menstrual periods for three or more consecutive months. Anorexia may be further classified as a restricting type or binge-eating/purging type.

Bulimia. Bulimia (Greek for "ox hunger") is characterized by recurrent episodes of binge eating. Binging (eating an extreme amount of food) is accompanied by a sense of lack of control over amounts eaten, and a feeling of being unable to stop. The disorder is further classified as either purging or nonpurging bulimia depending on whether the individual uses fasting or exercise instead of purging to "compensate" for binging.

Binge Eating. Binge eating is sometimes termed "stress eating" or "emotional overeating." It is characterized by compulsive overeating, usually in secret and without purging, followed by guilt or remorse for the episode. It has been estimated that up to 40 percent of people with obesity may be binge eaters. The term "binge eating disorder" was officially introduced in 1992. Unlike nonpurging bulimia, there is no attempt to "compensate" for the binge by fasting or overexercising.

CAUSATION

Eating disorders can be considered biologically based alterations filtered through cultural pressures and individual psychology. The psychological aspects of anorexia are frequently thought to include conflicts between mothers and adolescent daughters over perfection. Bulimia is often thought to involve conflicts over dependence and loneliness. Binging may share causal factors with obsessive-compulsive behavior.

PREVALENCE AND RISK FACTORS

Since people commonly deny or try to hide their disordered eating behaviors, it is difficult to accurately estimate the number of people affected by these problems. Nonetheless, experts report approximately 1.2 million women in the United States are affected by anorexia or bulimia.

Anorexia is more present in developed societies, especially in societies where being attractive is linked to being thin. The prevalence of anorexia has been estimated to be 0.5 to 1 percent of the population, and rates appear to be increasing. The condition usually begins in early adolescence (13–18 years) and 90 percent of the cases are female. Occasionally, but rarely, the disorder may begin in someone over age forty. Stressful life events (e.g., leaving home for college) occasionally trigger the onset of the problem. Long-term death rates from anorexia approach 10 percent, with death usually resulting from starvation, suicide, or electrolyte imbalance.

The chances of developing an eating disorder are higher among females (female cases outnumber male cases 10 to 1), among those pressured by society or family to be thin, and among athletes. Athletes for whom weight control and/or thinness provides an advantage (e.g., gymnastics, wrestling) are particularly susceptible to eating disorders. Psychological factors that put a person at risk for disordered eating include low self-esteem, poor coping ability, perfectionism, and body image distortion. Genetics may also play a role. Risk increases among those with a close relative (a parent or sibling) with an eating disorder, especially with binging/purging.

IMPACT

Eating disorders cause an array of medical problems ranging from fatigue to illness, and occasionally death. Even when eating disorders do not reach this level of severity they can be significant sources of suffering for the patient and family members. Mild complications include lack of energy, cavities, cold intolerance, irregular periods, constipation and diarrhea, and difficulty with concentration. Serious complications include electrolyte instability, irregular heartbeat, suicidal tendencies, and death. Between 5 to 18 percent of those with anorexia or bulimia will die from complications of the disorder.

Malnourishment and self-starvation affect the heart, thyroid, and the digestive and reproductive systems, as well as seriously decreasing bone density. Specific problems seen in athletes with eating disorders include impaired athletic performance and an increased risk of injuries and stress fractures. Female athletes with an eating disorder may be considered to have the "female athlete triad" if they manifest symptoms of: (1) disordered eating (which leads to decreased body fat causing a lower estrogen level); (2) amenorrhea (not having a period for three consecutive cycles because of low estrogen); and (3) osteoporosis (fragile bones because of low estrogen).

Although eating disorders are not contagious, the culture in which the person lives can contribute to the spread of an eating disorder, particularly in cultures that glorify thinness. Although obesity may be a consequence of binge eating, it does not typically result from the major eating disorders. Prevention efforts may help, and early detection efforts are essential as patients do not typically request treatment for themselves. Psychological consequences of semistarvation include depressed mood, social withdrawal, insomnia, irritability, and loss of libido, as well as obsessive thoughts about food.

TREATMENT

The most important factor in treating people with eating disorders is the recognition of the disorder. Disordered eating is usually not self-diagnosed because of associated denial and embarrassment. Anorexics usually do not even realize there is a problem with their behavior, and bulimics usually realize the problem but try to hide their behavior. Family, friends, or health care professionals are often the people who recognize the problem. A team treatment approach is frequently employed, consisting of a physician, a nutritionist, and a psychologist. Medically, antidepressants may be needed, and complications may require treatment or hospitalization if the situation is severe enough. Nutritionally, people with disordered eating need to learn how to eat in a healthful way. Psychologically, modification of inappropriate food-related behavior and development of improved coping mechanisms are necessary. In addition, changes in body image and ideal body image may be necessary.

Treatment, especially for anorexia, can be a long drawn-out affair, and it can take a big toll on family resources and on the social productivity of the person. Recovery from these disorders is difficult, and estimates of 50 percent relapse rates for anorexia and 33 percent for bulimia are common. A difficulty in the control of disordered eating behaviors is the need to continue to eat. This it is in contrast to other disorders of habit or addiction in which treatment involves total avoidance of the abused substance.

RESOURCES

The Academy of Eating Disorders (http://www.acadeatdis.org) is a multidisciplinary professional group devoted to the improved detection and treatment of these conditions. Efforts to expand screening are promoted through eating disorders awareness week on U.S. college campuses, and this has now been expanded to high school and the general public (http://www.nmisp.org/eat.htm).

Other valuable resources include the following:

* American Anorexia/Bulimia Association, 165 West 46th Street #1108, New York, New York 10036; (212) 575–6200, http://www.aabainc.org/
* National Eating Disorders Organization (formerly the National Anorexic Aid Society), 6655 South Yale Avenue, Tulsa, Oklahoma 74136; (918) 481–4044, http://www.kidsource.com/nedo/
* Overeaters Anonymous Headquarters, World Service Office, 6075 Zenith Court NE, Rio Rancho, New Mexico 87124;(505) 891–2664, http://www.overeatersanonymous.org/

LEONARD J. HAAS

TRISHA PALMER

(SEE ALSO: Anorexia; Menstrual Cycle; Mental Health; Nutrition; Social Determinants)

BIBLIOGRAPHY

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington, DC: Author.

American Psychiatric Association (2000). "Practice Guideline for the Treatment of Patients with Eating Disorders (Revision)." American Journal of Psychiatry 157 (January Supp.):1.

Browell, K. D., and Fairburn, C. G., eds. (1995). Eating Disorders and Obesity. New York: Guilford Press.

Christensen, L. (1996). Diet-Behavior Relationships: Focus on Depression. Washington, DC: American Psychological Association Books.

Danowski, D., and Lazora, P. (2000). Why Can't I Stop Eating? Recognizing, Understanding, and Overcoming Food Addiction. Center City, MN: Hazelden Information Education Services.

Fairburn, C. G. (1995). Overcoming Binge Eating. New York: Guilford Press.

Natenshon, A. H. (1999). When Your Child has an Eating Disorder: A Step-by-step Workbook for Parents and Other Caregivers. San Francisco: Jossey Bass Publishers.

Siegel, M.; Brisman, J.; and Weinshel, M. (1997). Surviving an Eating Disorder: New Perspectives and Strategies for Family and Friends. New York: Harper Collins.

Stunkard, A. J., and Wadden, T. (ed.) 1993. Obesity: Theory and Therapy. Lancaster, CA: Raven Press.

Thompson, A. K., ed. (1996). Body Image, Eating Disorders and Obesity: An Integrated Guide to Assessment and Treatment. Washington, DC: American Psychological Association Books.

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Definition

Wax blockage is an obstruction of the ear canal with wax (cerumen).

Symptoms

* Earache
* Fullness in the ear or a sensation that the ear is plugged
* Noises in the ear (tinnitus)
* Partial hearing loss, may get worse

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Definition

E. coli enteritis is inflammation of the small intestine from Escherichia coli (E. coli) bacteria. It is the most common cause of travelers' diarrhea.

Symptoms

Symptoms occur when the E. coli bacteria enters the intestine. The time between being infected and developing symptoms is usually 24 - 72 hours. Symptoms may include:

* Abdominal pain
* Diarrhea that is sudden and severe, and may be bloody
* Fever
* Gas
* Loss of appetite
* Stomach cramping
* Vomiting (rare)

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Definition

Dysthymia is a chronic type of depression in which a person's moods are regularly low. However, it is not as extreme as other types of depression.

Symptoms

The main symptom of dysthymia is low, dark, or sad mood nearly every day for at least 2 years. The symptoms are less severe than in patients with major depression, but people with this condition can still struggle with:

* Feelings of hopelessness
* Insomnia or hypersomnia
* Low energy or fatigue
* Low self-esteem
* Poor appetite or overeating
* Poor concentration

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Definition

Dyshidrotic eczema is a condition in which small, itchy blisters develop on the hands and feet.

Symptoms

Small fluid-filled blisters called vesicles appear on the fingers, hands, and feet. They are most common along the edges of the fingers, toes, palms and soles. These blisters cause intense itching and scaly patches of skin that flake constantly or become red, cracked, and painful.

Scratching leads to skin changes and skin thickening. Large blisters may cause pain.

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Definition

Dysfunctional uterine bleeding (DUB) is abnormal bleeding from the vagina that is due to changes in hormone levels.

Symptoms

A woman with dysfunctional uterine bleeding may notice the following changes in her menstrual cycle:

* Bleeding or spotting from the vagina occurs between periods
* Menstrual periods may be less than 28 days (more common) or more than 35 days apart
* Time between menstrual periods changes with each cycle
* Bleeding is heavier (passing large clots, needing to change protection during the night, soaking through a sanitary pad or tampon every hour for 2 - 3 hours in a row)
* Bleeding lasts for more days than normal or for more than 7 days

Other symptoms caused by changes in hormone levels are:

* Excessive growth of body hair in a male pattern (hirsutism)
* Hot flashes
* Mood swings
* Tenderness and dryness of the vagina

A woman may feel tiredness or fatigue if she is losing too much blood over time and becomes anemic.

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